To suggest a phonosurgical management strategy that can be used for children who have previously undergone laryngotracheal reconstruction.

This cases series describes three children who presented with complex, multi-level airway stenosis and marked dysphonia. Phonosurgical intervention involved endoscopic and open approaches, and was combined with voice therapy. A phonosurgical reconstruction management algorithm is suggested for evaluating and treating these complex conditions.

Pre-operative assessment is critical, and should involve voice analysis and glottal anatomy assessment using office laryngoscopy and stroboscopy. The risks must be weighed up against the benefit of vocal improvement. Surgical intervention should involve combined endoscopic and open approaches.

Voice restoration after paediatric airway reconstruction is a complex challenge. Surgical intervention should be conducted in a step-by-step manner to reduce the risk of worsening dysphonia and airway compromise. The risks and benefits must be carefully explored and discussed.

To report a case of successful bone-anchored hearing aid implantation in an adult patient with type III osteogenesis imperfecta, which is commonly regarded as a contraindication to this procedure.

A 45-year-old man with type III osteogenesis imperfecta presented with mixed hearing loss. There was a mild sensorineural component in both ears, with an air–bone gap between 45 and 50 dB HL. He was implanted with a bone-anchored hearing aid. The audiological outcome was good, with no complications and good implant stability (as measured by resonance frequency analysis).

To our knowledge, this is the first recorded case of bone-anchored hearing aid implantation in a patient with osteogenesis imperfecta.

Endoscopic endonasal techniques have recently become the method of choice in dealing with cerebrospinal fluid leak involving the anterior cranial fossa. However, most surgeons prefer an intracranial approach when leaks involve the middle cranial fossa. This case report illustrates the possibilities of using endoscopic techniques for cerebrospinal fluid leaks involving the middle fossa.

A 37-year-old male patient presented with multiple areas of cranial defect with cerebrospinal fluid leak due to osteoradionecrosis following radiation for nasopharyngeal carcinoma 4 years earlier. Clinical examination showed involvement of all cranial nerves except the IInd and XIth nerves on the left side. A prior attempt to repair the cerebrospinal fluid leak with craniotomy was not successful.

This case demonstrates the successful endoscopic repair of a large cranial defect with cerebrospinal fluid leak.

Aspiration pneumonia is an important cause of death in head and neck cancer patients. This study therefore aimed to evaluate the risk factors associated with aspiration pneumonia in head and neck cancer patients.

Hospital death records from 12 years (2000–2012) were reviewed to obtain the number of deaths. Treatment details and cause of death were analysed. Statistical analysis was performed to identify the risk factors for aspiration pneumonia.

The records revealed that aspiration pneumonia was the cause of death in 51 out of 85 patients. Primary tumour site (oropharynx and hypopharynx, odds ratio 3.3; 95 per cent confidence interval 1.17–9.4, p = 0.02) and advanced tumour stage (odds ratio 4.2, 95 per cent confidence interval 1.16–15.61, p = 0.02) had significant negative impacts on aspiration pneumonia related mortality.

Advanced pharyngeal cancer patients are at an increased risk of aspiration pneumonia related death. Investigations for the early detection of this condition are recommended in these high-risk patients.

Necrotising (malignant) otitis externa is a severe infection causing temporal bone osteomyelitis. Although rare, our experience (reported herein) shows local doubling of cases in 2013. Hospital Episodes Statistics data for England over 14 years also indicate increased incidence nationally. Specific learning points in management are also discussed.

A retrospective review was conducted of patients admitted in 2013 to Wexham Park Hospital, Slough, UK (catchment population, 450 000). In addition, the UK Government Hospital Episodes Statistics data were interrogated.

There were five cases of necrotising (malignant) otitis externa in 2013, representing a local doubling on previous years. The mean age of patients was 82 years. All cultures grew Pseudomonas aeruginosa; no isolates were antibiotic resistant. All patients responded to systemic anti-pseudomonals on clinical, biochemical and radiological parameters. Hospital Episodes Statistics data showed a six-fold increase in the number of cases from 1999 (n = 67) to 2013 (n = 421).

Our experience suggests increasing necrotising (malignant) otitis externa incidence, and retrospective analysis of Hospital Episodes Statistics data supports this observation. Necrotising (malignant) otitis externa poses challenges in management, as exemplified in our cases, requiring a high index of suspicion and early aggressive treatment to achieve cure.

To identify clinical factors that can explain the differences in treatment outcome, and examine the value of human papillomavirus infection as a prognostic biomarker in stage IVa tonsillar carcinomas.

Fifty-nine patients with tonsillar carcinoma classified as stage IVa were retrospectively analysed for survival outcomes according to various clinical factors. Human papillomavirus infection was evaluated using a human papillomavirus DNA chip test and immunohistochemical staining for p16 and p53.

Lower disease-free survival rates were associated with increasing local invasiveness and nodal status. Although human papillomavirus positivity and p16 expression was more common in locally advanced tonsillar carcinomas with advanced nodal status, the overall survival rate was better for patients with human papillomavirus positive, p16-positive tumours.

The disease-free survival rate may differ according to local tumour invasiveness and nodal status, even for stage IVa tonsillar cancers. Human papillomavirus infection may be a useful biomarker for predicting treatment outcomes for stage VIa tumours.

Nasal gliomas are congenital neurogenic tumours that are mostly diagnosed in the perinatal period. They occur in 1 in 20 000–40 000 live births. Cases reported in adulthood are rare and the management in adults is controversial.

A 55-year-old female had an incidental diagnosis of nasal glioma after routine endoscopic sinus surgery and polypectomy. Post-operatively, there was symptomatic improvement, but it was complicated by a cerebrospinal fluid leak.

Most adults who present with nasal gliomas have non-specific nasal symptoms, and diagnosis is made from an incidental finding of heterotopic glial tissue. The management of nasal gliomas in adults is contentious. In contrast, management in the paediatric population is better established and the treatment is surgical excision. The relevant literature is reviewed.

Adenoidectomy and tonsillectomy are the oldest surgical procedures. The neutrophil-to-lymphocyte ratio is an inflammatory marker. This study aimed to investigate neutrophil-to-lymphocyte ratios in chronic tonsillitis patients and to determine whether this ratio reflects the pre- and post-operative inflammatory status in these patients.

Patients and healthy individuals were assigned to four groups: the adenoid hypertrophy, adenotonsillar hypertrophy, chronic tonsillitis and control groups. The neutrophil-to-lymphocyte ratio was calculated for each patient before surgery and one month post-surgery. Pre- and post-operative white blood cell, neutrophil and lymphocyte counts and neutrophil-to-lymphocyte ratios were compared both within and between groups.

Pre- and post-operative neutrophil-to-lymphocyte ratios were significantly higher in the chronic tonsillitis group than in the adenoid hypertrophy and adenotonsillar hypertrophy groups (p < 0.01 and p < 0.05, respectively). In the chronic tonsillitis group, post-operative neutrophil-to-lymphocyte ratios were significantly lower than pre-operative ratios (p = 0.045). The pre-operative neutrophil-to-lymphocyte ratio was significantly higher in the chronic tonsillitis group than in the adenoid hypertrophy, adenotonsillar hypertrophy and control groups (p = 0.000). In contrast, there was no significant difference in post-operative neutrophil-to-lymphocyte ratios among all groups (p = 0.584).

The neutrophil-to-lymphocyte ratio measurement can be used in chronic tonsillitis patients as an effective auxiliary method for determining the necessity and timing of tonsillectomy and post-operative follow up, thereby helping prevent complications due to delayed or inadequate treatment.

Tonsillectomy is one of the most commonly performed otolaryngological procedures. Bilateral palsy of the glossopharyngeal nerve is an exceedingly rare complication that can result in significant morbidity. This case report aimed to raise awareness of this complication and outline management strategies.

A 31-year-old woman who underwent routine tonsillectomy presented with progressive numbness of the palate, dysgeusia, xerostomia, paraesthesia of the tongue and the feeling of something in her throat within 2 weeks of surgery. She reported the post-operative onset of snoring. Examination revealed a symmetrically low, ‘dropped’ soft palate. Over time, her symptoms have lessened, but dysgeusia and snoring remain.

The position of the glossopharyngeal nerve in the tonsillar bed makes it prone to injury during tonsillectomy, especially if ‘hot’ methods are used. Bilateral injury can result in significant morbidity that can be difficult to treat. Patients should be warned about this risk and care should be taken to minimise it.

Liposarcomas rarely occur in the parapharyngeal space and only a few case reports exist. For curative therapy of liposarcoma, surgical excision remains the dominant modality. Although a wide surgical margin is important to prevent local recurrence, wide excision is often difficult in the head and neck region.

We report a case of a 19-year-old female with a well-differentiated liposarcoma arising in the parapharyngeal space. We removed the tumour surgically utilising a cervical–parotid approach. The histological diagnosis was well-differentiated sclerosing liposarcoma. There is no recurrence after five years and nine months of follow up.

The patient's age and the tumour site made it difficult for us to make a quantitative diagnosis before the operation. Well-differentiated liposarcoma rarely develop distant metastasis, but often recur locally. The benefit of adjuvant radiotherapy for well-differentiated liposarcoma is still not clear and careful and long-term follow up is necessary.

To report a rare case of simultaneous bilateral cochlear implantation in a five-month-old child with Usher syndrome.

Case report.

A five-month-old boy with Usher syndrome and congenital profound bilateral deafness underwent simultaneous bilateral cochlear implantation. The decision to perform implantation in such a young child was based on his having a supportive family and the desire to foster his audiological development before his vision deteriorated. The subject experienced easily resolvable intra- and post-operative adverse events, and was first fitted with an externally worn audio processor four weeks after implantation. At 14 months of age, his audiological development was age-appropriate.

Simultaneous bilateral cochlear implantation is possible, and even advisable, in children as young as five months old when performed by an experienced implantation team.

Spontaneous regression of solid malignancy is extremely rare. It is virtually unheard of in the last half century in the published literature. The overwhelming majority of medical professionals do not know that this phenomenon exists.

This paper reports such a case involving a patient with proven laryngeal squamous cell carcinoma in New Zealand. Whilst waiting for definitive treatment, he was afflicted with prolonged septicaemia secondary to peritonitis from percutaneous endoscopic gastrostomy tube insertion. Following a total laryngectomy, histology of the specimen did not contain any evidence of neoplasia.

Based predominantly on work established by Dr William Coley, we believe that a period of prolonged pyrexia preceding definitive surgery contributed to this apparent ‘miracle’. The time may be ripe to further debate on whether the medical profession should consider pyrexia therapy as a last resort treatment for patients deemed incurable by conventional methods.

Although other blood dyscrasias are known to cause sudden sensorineural hearing loss, macrocytosis has not previously been implicated in the absence of another causative agent.

We present a case of bilateral sequential sudden sensorineural hearing loss in a patient with significant macrocytosis (mean corpuscular volume at presentation 124 fl) secondary to alcohol-induced liver dysfunction.

A possible pathophysiological mechanism linking macrocytosis and sudden sensorineural hearing loss was identified, suggesting areas for further investigation.

This study aimed to evaluate the changes in impact factors of otorhinolaryngology journals over the past 15 years.

Using the online edition of Journal Citation Reports, standard (2-year) and 5-year impact factors were calculated for the leading 15 journals.

The results were compared with the impact factors for 1998. The average standard impact factor and 5-year impact factor increased by 2.72 and 2.05 fold respectively when compared with 1998. The average 2012 standard impact factor and 5-year impact factor were 1.82 and 1.99 respectively, reflecting a 9.3 per cent difference. The average 1998 standard impact factor and 5-year impact factor were 0.67 and 0.97 respectively, reflecting a 44.8 per cent difference. The Journal of the Association for Research in Otolaryngology had the highest standard and five-year impact factors.

These data may indicate changing clinical and research interests within our field, as well as increased speed and ease with which the internet has allowed citation. As a result, five-year intervals may no longer be necessary to adequately gauge journal impact.

We present the case of a rare cause of epistaxis in a paediatric patient, together with the diagnostic and management challenges associated with this condition.

A previously well nine-year-old boy presented with a six-month history of intermittent unilateral epistaxis. Radiological investigation and endoscopic biopsy confirmed a highly malignant nasopharyngeal mass consistent with carcinoma. The tumour continued to grow rapidly. Whilst awaiting intervention, the patient experienced a further significant haemorrhage requiring surgical intervention.

Nasopharyngeal carcinoma is a rare cause of epistaxis amongst children in the UK. Early flexible nasendoscopy can help delineate both benign and sinister causes of symptoms in this region.

This paper reports the outcome of using acellular dermal matrix to repair a cervical skin defect in a patient with an advanced laryngeal carcinoma that had invaded the skin.

A 55-year-old man underwent surgical repair of severe atypical hyperplasia and of a squamous cell carcinoma at 17 and 9 months, respectively, prior to undergoing the current procedure. Five months prior to the current procedure, his left cervical skin broke down and the lesion gradually enlarged. A pathological diagnosis of squamous cell carcinoma was made. The cervical skin defect was repaired with a tailored acellular dermal matrix patch. The cervical wound completely healed without developing infection or a pharyngeal fistula, and the patient exhibited no dysphagia three years after surgery.

Cervical skin defects can be successfully repaired with acellular dermal matrix.

Removing a button battery from the ear can be a tricky and challenging procedure.

We describe the innovative use of a magnetic telescopic rod to successfully remove a button battery from the ear canal of a nine-year-old boy.

We propose that this equipment should be available in ENT clinics and operating theatres to be used for removing foreign bodies made from ferrous materials.

The bone-anchored hearing aid implantation technique is associated with post-operative skin reactions, which require conservative therapy and, in some cases, replacement of the abutment. Z-plasty is a technique that allows resection of the granulation tissue, thus ensuring that disease-free skin will be in contact with the abutment.

Use of the Z-plasty technique for resection of the peri-abutment granulation tissue is described. In the case presented herein, the episodes of skin reaction became very frequent and the patient was unable to use his bone-anchored hearing aid for 2 to 3 days a week. We opted for surgical treatment with Z-plasty for management of the skin complications.

Use of the Z-plasty technique is recommended for the management of skin reactions associated with bone-anchored hearing aid implantation.

This study aimed to investigate the association of C-C chemokine receptor type 9 (CCR9) and C-C motif chemokine 25 (CCL25) expression levels with clinical and tumour–node–metastasis stage in nasopharyngeal carcinoma.

A total of 42 nasopharyngeal carcinoma patients (nasopharyngeal carcinoma group) and 18 patients with a normal nasopharynx (control group) were included in this study. Tissues were collected during surgery and medical examinations. The CCR9 and CCL25 messenger RNA and protein levels were measured using quantitative reverse transcription polymerase chain reaction, Western blotting and immunohistochemical analysis.

CCR9 and CCL25 messenger RNA and protein levels were significantly increased in the nasopharyngeal carcinoma group compared with the control group (p < 0.05). Both CCR9 and CCL25 messenger RNA and protein levels were significantly higher in advanced-stage nasopharyngeal carcinoma (stages III and IV) patients compared with early-stage nasopharyngeal carcinoma (stages I and II) patients (p < 0.05).

The extent of CCR9 and CCL25 upregulation in nasopharyngeal carcinoma correlates with the tumour–node–metastasis stage.